HomeMy WebLinkAboutBLD4795 Final Duplex - BLD Permit / Conditions - 5/24/1977 BUILDING PERMIT APPLICATION
MASON COUNTY
P.O. Box 186 Shelton, Washington 98584
DATE ISSUED f 7 7
PERMIT NO. 9?
OWNER NAME MAIL ADDRESS CITY B, TATE ZIP PHONE
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DIRECTIONS d G
TO JOB SITEea c
LEGAL L- ���. / 1A) F,j S / 0-4 SEE ATTACHED SHEET)
DESCR.
CONTRACTOR
NAME MAIL ADDRESS CITY&STATE LICENSE NO. PHONE
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USE OF Air
BUILDING / e C4'r.•
Class of work: NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
Describe work:
Valuation of work: $ PLAN CHECK FEE PERMIT FEE
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SPECIAL CONDITIONS:
A�LICATION PTE BY PLANS CHECK BY APPROVED FOR ISSUANCE Type of Occupancy Division
BY Const. Group
1-7
Size of Bldg. No. of Max.
(Total) Sq. Ft. ;lid Stories Occ. Load
CONTRACTOR AFFIDAVIT
PERMANENT SEASONAL E.D. NUMBER
I certify that I am a currently registered contractor in RESIDENCE
the State of Washington and I am aware Of the MOBILE HOME
ordinance requirements regulating the work for which
the permit is issued and all work done will be in Special Approvals Required Received Not Required
conformance therewith. ZONING
HEALTH DEPT.
Firm �- �� ►� C. PUBLIC WORKS
By
ROAD DEPT,
Lic. No.4Q- C uh 6Z� Z Date -r
ILL-2-P
OWNERS AFFIDAVIT
I certify that I am exempt from the requirements of the N O T I C E
contract or registration law RCW 18.27, and am aware
of the Mason County ordinance requirements for SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING,
which this permit is issued and that all work done will
be in conformance therewith. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED
IS NOT COMMENCED WITHIN 120 DAYS, OR IF CONSTRUCTION OR WORK IS
/ SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER
Owner = _ Date I LI WORK IS COMMENCED.
L CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH
MA,snN COUNTY P1 A NNjNr7 nFPARTn.AFNIT
P.O. BOX 186 Shelton, Washington 98584
PLUMBING PERMIT APPLICATION
IMPORTANT — Complete ALL items. Mark boxes where applicable.
Name Mailingaddress—Number,strest,r+ty,and State Zip code Tel.No.
1. 7YIT
Owner Y
2.
Contractor S n G / ` �
/C. �` �' 3 s'G
The owner of this building and the undersigned agree to conform to all applicable laws of IV--son County and State of Washington
Signature of applicant --- Address --- Application date
LEGAL DESCRIPTION
Location - — --Of
Building
NO. PLUMBING FIXTURES FEE
"Z- WATER CLOSETS p-p
Z BASINS I
Z— BATH TUBS Imp
SHOWERS \�
Z WATER HEATERS
-2— AUTO.WASHERS T
SINKS /C
FLOOR DRAINS
DRINKING FOUNTAINS
LAUNDRY TRAYS
Connect to City Sewer
DISH WASHER t �/
DISPOSAL
URINAL �' r
ex S
(Show Street Names & Property Lines)
v
INDICATE LOCATION OF MAIN SHUTOFF VALVE FOR WATER.
PERMIT SKETCH IN SEPTIC TANK& DRAIN FIELD LOCATION OR SUBMIT
ON OTHER SKETCH.
DO NOT WRITE IN THIS SPACE — FOR OFFICE USE
Approved b ` L
mit fee Date pemit issued Permit number Receipt No.
L - -
Farren, Michael #4795
5-24-77
E 142.5' W 285' S 168' as meas. W line
SE 1/4 SE 1/4 20-23-1
Contractor
Tyee Well Drilling Co.
Duple-r. (rental)
Plumbing Permit issued
$32,000.00
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